RN Client Focused Case Manager (Remote) - 40 Hours - Day Shift - Populance

Henry Ford Health System; Troy (MI); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse Client Focused Case Manager to join their remote team. This role involves supporting patients with diverse medical needs, conducting comprehensive assessments, and creating tailored care plans. Ideal candidates will possess strong communication and problem-solving skills, along with a passion for improving patient outcomes. Join a forward-thinking organization that values innovative care management and offers a collaborative environment to enhance the health and well-being of the community. If you are committed to making a difference in healthcare, this opportunity is for you.

Benefits

Tuition Reimbursement

Paid Time Off

Employee Assistance Program

Health and Wellness Programs

Retirement Programs

Day Care Services

Qualifications

• Minimum of 2 years experience in healthcare, preferably in case management.
• General understanding of Medicare and Medicaid regulations required.

Responsibilities

• Assess clinical and social determinants of health to drive service improvements.
• Develop and monitor patient-centered care plans collaboratively.

Skills

Communication Skills

Problem-Solving

Critical Thinking

Independence

Education

Degree in Nursing

Bachelor's Degree in Nursing

Tools

Epic

Job description

RN Client Focused Case Manager (Remote) - 40 Hours - Day Shift - Populance

REGISTERED NURSE CLIENT FOCUSED CASE MANAGER (REMOTE) - SUPPORTIVE CARE MANAGEMENT - 40 HOURS WEEKLY - DAY SHIFT - POPULANCE

Schedule: Days, Monday through Friday

GENERAL SUMMARY:

Unit Description:

Populance is growing our Client Focused Care Management team! We are seeking experienced, out-of-state Registered Nurses to support our work in Case Management. In this role, you will support patients of varying medical diagnoses individually, research care treatment pathways, and guide them on their journey to wellbeing. You will have the ability to work with individuals from Populance, HAP, and Henry Ford Health.If you have a passion for population health, we want to meet you!

Under the guidance of the Clinical Success leadership team, the Client Focused Case Manager is responsible for the collaborative practice of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health care needs though communication and available resources to promote patient safety, quality of care and cost-effective outcomes. The Client Focused Case Manager will offer continuous assistance and monitoring regarding the efficiency and appropriateness of healthcare services for clients. This involves assessing the effectiveness of medical diagnostics, treatments, and services to create optimized, evidence-based pathways that ensure the right care isprovided at the right time, promoting a person’s best state of health.

This role handles cases requiring extensive management, knowledge of benefits and resources. Essential skills include strong communication, problem-solving, critical thinking, and the ability to work independently in a fast-paced environment.

Dependent on volume, the Client Focused Case Management Nurse may also be responsible for handling case management requests within the state of Michigan.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Assess both clinical and social determinants of health (SDOH) to determine the need for healthcare services and drive improvements in utilization practices.
• Conducts research across various platforms, including Epic, to gather comprehensive data on the client’s healthcare history, current needs, and utilization patterns.
• Conducts a comprehensive assessment of patient’s and family/caregiver’s biomedical, psychological, social, and functional needs to gage the potential impact on recovery.
• Develop, implement, monitor, and modify a patient-centered plan of care through an interdisciplinary and collaborative team process, in conjunction with the patient, the caregivers and the healthcare team.
• Develop, implement, monitor, and modify a patient-centered plan of care through an interdisciplinary and collaborative team process, in conjunction with the patient, the caregivers and the healthcare team.
• Ensures ongoing monitoring and follow-up occurs to evaluate the effectiveness of interventions and adjust the plan as necessary to further reduce utilization and improve overall outcomes for Populance and its clients.
• Possess knowledge and serve as a liaison to ensure the provision of education, support services, and resources related to guidelines, community and provider support, network management, benefits, and case and care management programs.
• Possess an in-depth understanding of insurance and benefits structure for members inside and outside the state of Michigan according to the members overall line of business and contractual/regulatory requirements .
• Facilitate referrals as necessary and guide appropriate utilization .
• Utilizes professional judgment, critical thinking, motivational interviewing, and self-management techniques to assist patients in overcoming barriers to goal achievement.
• Identify and utilize alternative care options and cost-saving quality management processes to ensure members receive quality, cost-effective care that aligns with clinical appropriateness, regulatory guidelines, and community standards, encompassing both inpatient and outpatient utilization .
• Facilitates referrals for additional medical and ancillary services, including home healthcare, infusion therapy, palliative care, hospice, inpatient extended care facilities, and medical equipment and supplies, as needed.
• When utilization and quality issues arise, promptly refer cases or situations to the appropriate departments for further evaluation and escalation as necessary, ensuring timely and effective resolution.
• Advocates for appropriate delivery of services within the patient’s health plan benefit structure.
• Reviews, focuses and proactively identifies utilization patterns.
• Engage and support members to focus on more high value care.
• Coordinate efforts and ensure comprehensive patient-centered care across the health care continuum to improve quality of the member experience, improve discharge planning and transitions of care, and reduce readmissions while decreasing the total cost of care. Including identification of appropriate resource use.
• Maintains availability to patient/family/caregiver as a resource to facilitate communication among the multidisciplinary team and to monitor services rendered . Remains involved until the patient achieves the planned level of functional health or closure criteria are met.
• Meets productivity standards as established by department needs and metrics.
• Advise systems on how to promote health focused delivery.
• Perform all other related duties as assigned.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.

EDUCATION/EXPERIENCE REQUIRED:
• A degree in nursing required.
• Bachelor’s degree in nursing preferred.
• A minimum of 2 years of experience in the health care industry, preferably in a health plan setting, required.
• Experience in Case Management required.
• Experience in Utilization Management preferred.
• Experience in Health Plan preferred.
• General understanding of Medicare and Medicaid regulations, required.
• General understanding of MDHHS, DIFS, CMS, NCQA regulatory requirements required.
• Knowledge of medical ethics and legal implications related to case management.
• Ability to prioritize and reprioritize quickly.
• Strong computer skills and knowledge.

CERTIFICATIONS/LICENSURES REQUIRED:
• Registered Nurse (RN) with a valid, unrestricted State of Michigan license, AND Registered Nurse (RN) with a valid, unrestricted Muti-State Licensure. RN must reside in a state that is part of the Nurse Compact state licensure.

• Certification in Case Management (CCM) by the Commission for Case Management Certification (CCMC) preferred.

Overview

HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.

Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a

$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s

major academic medical centers, receiving between $90-$100 million in annual research funding and

remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

education and training, the health system has trained nearly 40% of physicians currently practicing

in the state and also provides education and training for other health professionals including nurses,

pharmacists, radiology and respiratory technicians. visitHenryFord.com .

Whether it's offering a new medical option, helping you make healthier lifestyle choices or

making the employee enrollment selection experience easier, it's all about choice. Henry

Ford Health System has a new approach for its employee benefits program - My Choice

Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

dozens of options for all of our employees including compensation, benefits, work/life balance

and learning - options that enhance your career and add value to your personal life. As an

employee you are provided access to Retirement Programs, an Employee Assistance Program

(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness

and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other

benefits and services. Employee'sclassified as contingent status are not eligible for benefits

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.

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